Family intervention in Psychosis Flashcards
In early psychosis what percentage percentage of parent are in a carer role?
60-70% in caring role
Benefits of having a carer in psychological interventions?
Having a carer has been associated with reduced hospital admissions and with an enhanced response to psychological interventions
What’s the mental health impact on carers within psych interventions?
Increased levels of distress, depression and anxiety
80% of carers report burden of care 78% high burnout
At least 30% of carers meet criteria for PTSD ,44% PTSS
What does the carer wellbeing intervention consist of?
Aims include: support carers, address isolation, hope, self-care, maintain own social network, crisis plan
6-8 sessions, protocol
What does EE stand for?
Expressed Emotion - A measure of the quality of the family interaction.
Initially measured with Camberwell Family Interview (Vaughn & Leff, 1976): semi-structured, carer’s responses coded on content, tone and emphasis
Although it refers to 5 components (criticism, hostility, emotional over-involvement, warmth & positive remarks) only the 1st three are used to calculate the EE Index
What are some of the expressions of criticism within this carer EE context?
Pessimistic illness beliefs
Poor knowledge about psychosis
Attribution of blame and responsibility to SU
Carer low self-esteem
Belief it’s useful strategy in controlling symptoms
Longer DUP + poor social functioning
What are some of the expressions of emotional over involvement within this carer EE context?
Self-blaming attributions & controlling behaviours
High level of contact
Return to the parental role to ‘look after’
Carer exhaustion, high burden of care
Common in EI
Why Does EE Matter In Psychosis?
High EE is a strong and reliable predictor of clinical outcome in patients
Higher risk of relapse for patients living in high EE environments compared to low EE environments (see meta-analyses: Bebbington & Kuipers, 1994; Butzlaff & Hooley, 1998)
Cross-cultural, meta-analytic review on EE and outcome (O’Driscoll et al., 2019): Association holds across geographical regions*
Families who benefit from FI show a reduction in the levels of expressed emotion (Bustillo et al 2001; Dixon et al. 2000; Haddock & Lewis, 2005; Pilling et al. 2002)
What is the aim of a family intervention for psychosis?
Aim: reduce levels of distress in the family to promote sustained recovery, reduce criticism, “over-involvement”, hostility and improve warmth
Targets: improve communication, cognitive reappraisal of difficulties, improve understanding of illness, develop problem solving, improve coping, promote independence, instil hope, identify strengths
Common Features of Evidence-based FI in Psychosis?
Stress-vulnerability model of psychosis
Non-blaming and positive attitude to families
Normalising approach to family reactions to psychosis
Needs and strengths of families are explicitly acknowledged
Problem-solving
Facilitating communication
Emotional processing
Cognitive reappraisal of difficulties
What are some of the theorised causes of psychosis?
Stressful life events. For example, being unemployed, repeated failure in the context of family ethics that values productivity and work
Triggering event- not being offered a job (meter reader) that Mark considered to be below his capacity
Heredity (particularly in a first degree relative)
Sleep deprivation
Isolation from friends/family
Cannabis use
